Imagine if you could lose weight by not just watching what you eat, but by how you think? New research by clinical psychologist and UTS Research Fellow Jay Raman suggests the key to sustained weight loss lies with our ‘executive function’ – the ability to pay attention to details, plan, organise and make healthy decisions. It’s a revolutionary approach that’s set to offer tangible, inexpensive obesity treatments that trim waistlines and government spending.
Obesity is one of the greatest causes of preventable morbidity and mortality worldwide. In Australia, almost two-thirds of adults are overweight or obese. And despite the fact that overweight and obesity significantly contribute to heart disease, hypertension, diabetes, stroke, dementia and certain types of cancer, treatment options remain poor.
In today’s information-rich world, we’re constantly saturated with lifestyle advice as to how much and what we should eat, how much we need to exercise and where we should go to seek help. Yet, paradoxically, obesity is escalating in pandemic proportions. Even with the help of professionals and extended behavioural treatments, statistics show, for most people, weight regain typically re-occurs when that professional contact ends.
So, what hope have we got?
As obesity typically develops when an individual’s energy intake exceeds expenditure, it’s critical to address disordered eating behaviours. In order to overcome unhealthy eating habits and resist temptation towards highly appealing but unhealthy food, individuals have to attend to details, plan, organise and make healthy decisions. These thinking skills are aspects of ‘executive function’.
In order to overcome unhealthy eating habits and resist temptation towards highly appealing but unhealthy food, individuals have to attend to details, plan, organise and make healthy decisions
Executive function is an umbrella term for the neurologically based skills involving mental control and self-regulation. Executive deficits, therefore, can lead to impaired performance in goal-directed behaviours, delaying rewards, difficulty adapting to change, difficulties putting a sequence of steps in order, difficulties shifting perspectives, impulse control problems, poor planning and decision making difficulties. Sound familiar?
Current weight loss treatments assume that in obesity, people have sufficient cognitive resources so they are able and ready to follow the recommendations during and after the treatments, and they are able to make the required choices in their lifestyle change. But that’s not always the case.
There is emerging evidence of a negative association between obesity and executive function. For example, in adults with obesity, evidence has demonstrated executive deficits in inhibitory control and inhibition response leading to disinhibited eating, greater food cravings, impulse dysregulation and decision-making impairments. Hence, executive deficits can make weight management highly challenging and onerous in obesity.
The two hallmark features of obesity maintenance, namely habit and temptation, rely heavily on our executive abilities. Despite our earnest efforts, yielding to habit and temptation can sabotage even the best laid plans for weight loss. Despite substantial research showing neurocognitive deficits in obesity, these processes are not addressed in current weight loss programs.
In my doctoral studies, completed last year, I implemented a novel treatment called cognitive remediation therapy for obesity (CRT-O). This study showed improvement in cognitive flexibility was a predictor of clinically significant and sustainable weight loss – that is where, three-months post-therapy, the participants in the treatment group lost more than five per cent of their body weight. This study also found CRT-O improved the mental health-related quality of life in people with obesity.
Jay Raman. Photo by Shane Lo
Since then, we have translated our growing body of knowledge into the cognitive remediation enabled cognitive behavioural therapy (CR-CBT) program – it’s a world-first for obesity treatment.
CR-CBT, as its name suggests, aims to improve brain function so as to aid weight loss and maintenance. This treatment has been specially tailored to address the habit and temptation aspects in individuals with obesity using both cognitive remediation therapy (CRT) and cognitive behavioural therapy (CBT).
The CRT addresses the implicit and autonomic processes (for example, problem-solving skills are taught using games, puzzles and other tasks), while CBT modifies unhelpful attitudes and behaviours (for example, participants are taught skills to cope with dissatisfaction when they first try temptation resistance strategies).
I’m currently running two case series pilots. One is individual face-to-face treatment in a community setting and the other is group-based therapy in a metabolic clinic setting. In these pilots, my team and I are looking at changes in weight loss, maintenance, improvements in heart and metabolic functions as well as habit and temptation-related behaviours. We’re also looking at the quality of life at the end of treatment and at three- and six-months post treatment.
These pilots are the first systematically developed psychological intervention program of their kind. They are informed from a strong empirical basis and will potentially aid in weight loss and weight loss maintenance, heart and metabolic health and also improve health-related quality of life in obesity.
Given the substantial economic and wellbeing costs of obesity, it’s vital to identify cost-effective means to help individuals achieve sustainable weight loss. The success of our projects will have major ramifications for community-wide, tangible and cheap treatment options for obesity.
Graduate School of Health